RESUMEN
BACKGROUND: Western guidelines often recommend biguanides as the first-line treatment for diabetes. However, dipeptidyl peptidase-4 (DPP-4) inhibitors, alongside biguanides, are increasingly used as the first-line therapy for type 2 diabetes (T2DM) in Japan. However, there have been few studies comparing the effectiveness of biguanides and DPP-4 inhibitors with respect to diabetes-related complications and cardio-cerebrovascular events over the long term, as well as the costs associated. OBJECTIVE: We aimed to compare the outcomes of patients with T2DM who initiate treatment with a biguanide versus a DPP-4 inhibitor and the long-term costs associated. METHODS: We performed a cohort study between 2012 and 2021 using a new-user design and the Shizuoka Kokuho database. Patients were included if they were diagnosed with T2DM. The primary outcome was the incidence of cardio-cerebrovascular events or mortality from the initial month of treatment; and the secondary outcomes were the incidences of related complications (nephropathy, renal failure, retinopathy, and peripheral neuropathy) and the daily cost of the drugs used. Individuals who had experienced prior events during the preceding year were excluded, and events within 6 months of the start of the study period were censored. Propensity score matching was performed to compare between two groups. RESULTS: The matched 1:5 cohort comprised 529 and 2,116 patients who were initially treated with a biguanide or a DPP-4 inhibitor, respectively. Although there were no significant differences in the incidence of cardio-cerebrovascular events or mortality and T2DM-related complications between the two groups (p = 0.139 and p = 0.595), daily biguanide administration was significantly cheaper (mean daily cost for biguanides, 61.1 JPY; for DPP-4 inhibitors, 122.7 JPY; p<0.001). CONCLUSION: In patients with T2DM who initiate pharmacotherapy, there were no differences in the long-term incidences of cardio-cerebrovascular events or complications associated with biguanide or DPP-4 use, but the former was less costly.
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Biguanidas , Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Inhibidores de la Dipeptidil-Peptidasa IV , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biguanidas/efectos adversos , Biguanidas/economía , Biguanidas/uso terapéutico , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/tratamiento farmacológico , Estudios de Cohortes , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/economía , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/economía , Neuropatías Diabéticas/tratamiento farmacológico , Neuropatías Diabéticas/economía , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/economía , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Inhibidores de la Dipeptidil-Peptidasa IV/economía , Inhibidores de la Dipeptidil-Peptidasa IV/efectos adversos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/efectos adversos , Japón , Resultado del TratamientoRESUMEN
BACKGROUND: Financial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes. METHODS: Analyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006-2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities. RESULTS: During the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95% CI 1.04-1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95% CI 1.06-2.18) and negative financial hardship (adjusted HR 1.54 95% CI 1.02-2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95% CI 0.55-1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95% CI 1.07-1.93) was associated with incident DKD independent of other financial hardship measures. CONCLUSIONS: Financial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed.
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Nefropatías Diabéticas/economía , Nefropatías Diabéticas/psicología , Estrés Financiero , Anciano , Nefropatías Diabéticas/epidemiología , Costos de los Medicamentos , Femenino , Estudios de Seguimiento , Inseguridad Alimentaria , Costos de la Atención en Salud , Humanos , Estudios Longitudinales , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores Sociodemográficos , Estados Unidos/epidemiologíaRESUMEN
Highlights Based on nationwide insurance data in Korea, the use of dipeptidyl peptidase IV inhibitors (DPP-IVi) not requiring renal dose adjustment (NRDA DPP-IVi) is widespread in the type 2 diabetes chronic kidney disease (T2D CKD) population. Instead of prescribing NRDA DPP-IVi, the use of DPP-IVi requiring renal dose adjustment with appropriate renal dose adjustments in T2D CKD patients can achieve a considerable annual cost saving of up to 7.8%.
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Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/economía , Inhibidores de la Dipeptidil-Peptidasa IV/economía , Costos de la Atención en Salud , Insuficiencia Renal Crónica/economía , Adulto , Biomarcadores/análisis , Glucemia/análisis , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/patología , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/etiología , Dipeptidil Peptidasa 4/química , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Relación Dosis-Respuesta a Droga , Cálculo de Dosificación de Drogas , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análisis , Humanos , Masculino , Pronóstico , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/etiología , Adulto JovenRESUMEN
BACKGROUND: To discriminatively evaluate the cost-saving effects of a disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes. METHODS: This study links public medical insurance claims data to the health records of a disease management program for diabetic nephropathy patients. To account for selection bias caused by the non-randomized allocation of the disease management program for diabetes patients, we adopted a fixed-effect model of panel data analysis. To discriminatively evaluate the cost-saving effects of the disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes, we expanded the difference-in-differences analysis from the traditional two-period model to a three-period model, comprising the before-intervention, during-intervention, and after-intervention periods. Data were extracted from municipal public insurers in Kure, Japan. RESULTS: The cost-reduction effect in terms of treatment costs from the before-intervention period to the during-intervention period (the rectification effect) was 4.02%, and the cost-saving effect from the during-intervention period to the after-intervention period (the health improvement effect) was 2.95%. CONCLUSIONS: A disease management program for diabetes patients organized by local public insurers in Japan reduced costs both by amending treatment processes and by subsequently improving the prognosis of the disease.
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Diabetes Mellitus/terapia , Nefropatías Diabéticas/terapia , Diálisis/economía , Ahorro de Costo/métodos , Nefropatías Diabéticas/economía , Manejo de la Enfermedad , Femenino , Costos de la Atención en Salud , Gastos en Salud , Humanos , Japón , MasculinoRESUMEN
Asia is the largest and most populated continent in the world, with a high burden of kidney failure. In this Policy Forum article, we explore dialysis care and dialysis funding in 17 countries in Asia, describing conditions in both developed and developing nations across the region. In 13 of the 17 countries surveyed, diabetes is the most common cause of kidney failure. Due to great variation in gross domestic product per capita across Asian countries, disparities in the provision of kidney replacement therapy (KRT) exist both within and between countries. A number of Asian nations have satisfactory access to KRT and have comprehensive KRT registries to help inform practices, but some do not, particularly among low- and low-to-middle-income countries. Given these differences, we describe the economic status, burden of kidney failure, and cost of KRT across the different modalities to both governments and patients and how changes in health policy over time affect outcomes. Emerging trends suggest that more affluent nations and those with universal health care or access to insurance have much higher prevalent dialysis and transplantation rates, while in less affluent nations, dialysis access may be limited and when available, provided less frequently than optimal. These trends are also reflected by an association between nephrologist prevalence and individual nations' incomes and a disparity in the number of nephrologists per million population and per thousand KRT patients.
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Fallo Renal Crónico/terapia , Diálisis Renal/estadística & datos numéricos , Asia/epidemiología , Costo de Enfermedad , Países Desarrollados/economía , Países en Desarrollo/economía , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/terapia , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Hospitales Privados/economía , Hospitales Privados/estadística & datos numéricos , Hospitales Públicos/economía , Hospitales Públicos/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Fallo Renal Crónico/economía , Fallo Renal Crónico/epidemiología , Trasplante de Riñón/economía , Trasplante de Riñón/estadística & datos numéricos , Prevalencia , Utilización de Procedimientos y Técnicas/economía , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Diálisis Renal/economía , Cobertura Universal del Seguro de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Chronic kidney disease (CKD) is a progressive condition that leads to irreversible damage to the kidneys and is associated with an increased incidence of cardiovascular events and mortality. As novel interventions become available, estimates of economic and clinical outcomes are needed to guide payer reimbursement decisions. OBJECTIVE: The aim of the present study was to systematically review published economic models that simulated long-term outcomes of kidney disease to inform cost-effectiveness evaluations of CKD treatments. METHODS: The review was conducted across four databases (MEDLINE, Embase, the Cochrane library and EconLit) and health technology assessment agency websites. Relevant information on each model was extracted. Transition and mortality rates were also extracted to assess the choice of model parameterisation on disease progression by simulating patient's time with end-stage renal disease (ESRD) and time to ESRD/death. The incorporation of cardiovascular disease in a population with CKD was qualitatively assessed across identified models. RESULTS: The search identified 101 models that met the criteria for inclusion. Models were classified into CKD models (n = 13), diabetes models with nephropathy (n = 48), ESRD-only models (n = 33) and cardiovascular models with CKD components (n = 7). Typically, published models utilised frameworks based on either (estimated or measured) glomerular filtration rate (GFR) or albuminuria, in line with clinical guideline recommendations for the diagnosis and monitoring of CKD. Generally, two core structures were identified, either a microsimulation model involving albuminuria or a Markov model utilising CKD stages and a linear GFR decline (although further variations on these model structures were also identified). Analysis of parameter variability in CKD disease progression suggested that mean time to ESRD/death was relatively consistent across model types (CKD models 28.2 years; diabetes models with nephropathy 24.6 years). When evaluating time with ESRD, CKD models predicted extended ESRD survival over diabetes models with nephropathy (mean time with ESRD 8.0 vs. 3.8 years). DISCUSSION: This review provides an overview of how CKD is typically modelled. While common frameworks were identified, model structure varied, and no single model type was used for the modelling of patients with CKD. In addition, many of the current methods did not explicitly consider patient heterogeneity or underlying disease aetiology, except for diabetes. However, the variability of individual patients' GFR and albuminuria trajectories perhaps provides rationale for a model structure designed around the prediction of individual patients' GFR trajectories. Frameworks of future CKD models should be informed and justified based on clinical rationale and availability of data to ensure validity of model results. In addition, further clinical and observational research is warranted to provide a better understanding of prognostic factors and data sources to improve economic modelling accuracy in CKD.
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Enfermedades Cardiovasculares/economía , Atención a la Salud/economía , Nefropatías Diabéticas/economía , Modelos Económicos , Insuficiencia Renal Crónica/economía , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Análisis Costo-Beneficio , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/mortalidad , Progresión de la Enfermedad , Tasa de Filtración Glomerular , Humanos , Cadenas de Markov , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/mortalidad , Resultado del TratamientoRESUMEN
OBJECTIVES: Diabetic kidney disease (DKD) is a frequent complication of diabetes with potentially devastating consequences that may be prevented or delayed. This study aimed to estimate the health and economic benefit of earlier diagnosis and treatment of DKD. METHODS: Life expectancy and medical spending for people with diabetes were modeled using The Health Economics Medical Innovation Simulation (THEMIS). THEMIS uses data from the Health and Retirement Study to model cohorts of individuals over age 50 to project population-level lifetime health and economic outcomes. DKD status was imputed based on diagnoses and laboratory values in the National Health and Nutrition Examination Survey. We simulated the implementation of a new biomarker identifying people with diabetes at an elevated risk of DKD and DKD patients at risk of rapid progression. RESULTS: Compared to baseline, the prevalence of DKD declined 5.1% with a novel prognostic biomarker test, while the prevalence of diabetes with stage 5 chronic kidney disease declined 3.0%. Consequently, people with diabetes gained 0.2 years in life expectancy, while per-capita annual medical spending fell by 0.3%. The estimated cost was $12,796 per life-year gained and $25,842 per quality-adjusted life-year. CONCLUSIONS: A biomarker test that allows earlier treatment reduces DKD prevalence and slows DKD progression, thereby increasing life expectancy among people with diabetes while raising healthcare spending by less than one percent.
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Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/diagnóstico , Diagnóstico Precoz , Fallo Renal Crónico/prevención & control , Anciano , Anciano de 80 o más Años , Biomarcadores/análisis , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 1/economía , Diabetes Mellitus Tipo 2/economía , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/epidemiología , Progresión de la Enfermedad , Femenino , Costos de la Atención en Salud , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/epidemiología , Esperanza de Vida , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Modelos Económicos , Método de Montecarlo , Encuestas Nutricionales/economía , Encuestas Nutricionales/estadística & datos numéricos , Prevalencia , Pronóstico , Factores de RiesgoRESUMEN
INTRODUCTION: Renin-angiotensin system inhibitors (RAS) drugs have a proteinuria-reducing effect that could prevent the progression of kidney disease in diabetic patients. Our study aimed to assess the budget impact based on healthcare payer perspective of increasing uptake of RAS drugs into the current treatment mix of standard anti-hypertensive treatments to prevent progression of kidney disease in patient's comorbid with hypertension and diabetes. METHODS: A Markov model of a Malaysian hypothetical cohort aged ≥30 years (N = 14,589,900) was used to estimate the total and per-member-per-month (PMPM) costs of RAS uptake. This involved an incidence and prevalence rate of 9.0% and 10.53% of patients with diabetes and hypertension respectively. Transition probabilities of health stages and costs were adapted from published data. RESULTS: An increasing uptake of RAS drugs would incur a projected total treatment cost ranged from MYR 4.89 billion (PMPM of MYR 27.95) at Year 1 to MYR 16.26 billion (PMPM of MYR 92.89) at Year 5. This would represent a range of incremental costs between PMPM of MYR 0.20 at Year 1 and PMPM of MYR 1.62 at Year 5. Over the same period, the care costs showed a downward trend but drug acquisition costs were increasing. Sensitivity analyses showed the model was minimally affected by the changes in the input parameters. CONCLUSION: Mild impact to the overall healthcare budget has been reported with an increased utilization of RAS. The long-term positive health consequences of RAS treatment would reduce the cost of care in preventing deterioration of kidney function, thus offsetting the rising costs of purchasing RAS drugs. Optimizing and increasing use of RAS drugs would be considered an affordable and rational strategy to reduce the overall healthcare costs in Malaysia.
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Antagonistas de Receptores de Angiotensina/economía , Inhibidores de la Enzima Convertidora de Angiotensina/economía , Antihipertensivos/economía , Análisis Costo-Beneficio , Costos de la Atención en Salud , Adulto , Antagonistas de Receptores de Angiotensina/farmacología , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/farmacología , Antihipertensivos/uso terapéutico , Presupuestos , Estudios de Cohortes , Comorbilidad , Ahorro de Costo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/prevención & control , Progresión de la Enfermedad , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/economía , Hipertensión/epidemiología , Incidencia , Malasia/epidemiología , Modelos Económicos , Prevalencia , Sistema Renina-Angiotensina/efectos de los fármacosRESUMEN
OBJECTIVES: To explore how the use of EQ-5D-5L value set and crosswalk from EQ-5D-5L to EQ-5D-3L (and use of 3L value set) would affect cost-effectiveness analysis results for England and six other countries (Canada, the Netherlands, China, Japan, South Korea, and Singapore). METHODS: Individual-level utilities derived from primary 5L data using both value set (5L) and crosswalk (c5L) approaches were applied to three Markov models assessing the cost-effectiveness of hemodialysis (HD) and peritoneal dialysis (PD) for end-stage renal disease (ESRD) patients to estimate incremental quality-adjusted life years (QALYs). The mathematic functions between incremental QALY and utility were derived. RESULTS: 5L- and c5L-based incremental QALYs were similar in the model for non-diabetic patients (range: 1.910-2.149, 1.922-2.121). 5L tends to generate more incremental QALYs than c5L in the model for diabetic patients (range: 1.454-1.633, 1.365-1.568) but fewer incremental QALYs in the model for all ESRD patients (range: 0.290-0.480, 0.315-0.493). In all models, 5L (c5L) generated more incremental QALYs when Chinese (South Korean) value sets were used. The largest and smallest differences in 5L- and c5L-based incremental QALYs were observed when Chinese and Dutch value sets were used. Incremental QALYs was a positive linear function of both utility of PD and difference in utilities of HD and PD. CONCLUSIONS: The value set and crosswalk approaches may not be used interchangeably in economic evaluation when EQ-5D-5L data are used to estimate utilities. Results of cost-effectiveness analysis using Markov models may be affected by both absolute utilities and their differences.
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Nefropatías Diabéticas/economía , Nefropatías Diabéticas/terapia , Costos de la Atención en Salud , Indicadores de Salud , Fallo Renal Crónico/economía , Fallo Renal Crónico/terapia , Evaluación de Procesos y Resultados en Atención de Salud/economía , Diálisis Peritoneal/economía , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Diálisis Renal/economía , Encuestas y Cuestionarios , Asia , Canadá , Análisis Costo-Beneficio , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/psicología , Europa (Continente) , Humanos , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/psicología , Cadenas de Markov , Modelos Económicos , Diálisis Peritoneal/efectos adversos , Valor Predictivo de las Pruebas , Diálisis Renal/efectos adversos , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
AIM: We aim to examine difference in incremental direct medical costs between non-progressive and progressive chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) in Singapore. METHODS: This was a prospective study on 676 patients with T2DM attending a diabetes centre in a regional hospital. Annual direct medical costs were extracted from the administrative database. Ordinary least squares regression was used to estimate contribution of CKD progression to annual costs, adjusting for demographics and baseline clinical covariates. RESULTS: Over mean follow-up period of 2.8 ± 0.4 years, 266 (39.3%) had CKD progression. The excess total follow-up medical costs from baseline was S$4243 higher in progressors compared to non-progressors (P = 0.002). The mean cost differential between the two groups increased from S$2799 in Stages G1-G2 to S$11180 in Stage G4. Inpatient cost accounted for 63.4% of total cost of progression. When stratified by glomerular filtration rate stages, the respective total mean annual costs at stages glomerular filtration rate Stages G3a-G3b and G4 were S$3290 (132%; P = 0.001) and S$4416 (135%; P = 0.011) higher post-progression. CONCLUSION: Chronic kidney disease progression in T2DM is associated with high medical costs. The cost of progression is higher with higher severity of CKD stage at baseline and could be largely driven by inpatient admission.
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Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/terapia , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/terapia , Costos de la Atención en Salud , Insuficiencia Renal Crónica/economía , Insuficiencia Renal Crónica/terapia , Anciano , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/epidemiología , Progresión de la Enfermedad , Femenino , Costos de Hospital , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Índice de Severidad de la Enfermedad , Singapur/epidemiología , Factores de TiempoRESUMEN
AIM: Although a National Health Screening Program (NHSP) for chronic kidney disease (CKD) has been implemented in Korea since 2002, its cost-effectiveness has never been determined. This study aimed to estimate the cost-utility of NHSP for CKD in Korea. METHODS: A Markov decision analytic model was constructed to compare CKD screening strategies of the NHSP with no screening. We developed a model that simulated disease progression in a cohort aged 20-120 years or death from the societal perspective. RESULTS: Biannual screening starting at age 40 for CKD by proteinuria (dipstick) and estimated glomerular filtration ratio had an ICUR of $66 874/QALY relative to no screening. The targeted screening strategy had an ICUR of $37 812/QALY and $40 787/QALY for persons with diabetes and hypertension, respectively. ICURs improved with lower cost strategies. The most influential parameter that might make screening more cost-effective was the effectiveness of treatment on CKD to decrease disease progression and mortality. CONCLUSIONS: The Korean NHSP for CKD is more cost-effective for patients with diabetes or hypertension than the general population, consistent with prior studies. Although it is too early to conclude the cost-effectiveness of the Korean NHSP for CKD, this study provides evidence that is useful in evaluating the cost-effectiveness of CKD interventions.
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Costos de la Atención en Salud , Tamizaje Masivo/economía , Programas Nacionales de Salud/economía , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/economía , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Simulación por Computador , Análisis Costo-Beneficio , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/terapia , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/epidemiología , Masculino , Cadenas de Markov , Persona de Mediana Edad , Modelos Económicos , Valor Predictivo de las Pruebas , Pronóstico , Proteinuria/diagnóstico , Proteinuria/economía , Proteinuria/epidemiología , Proteinuria/terapia , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , República de Corea/epidemiología , Factores de Riesgo , Factores de Tiempo , Urinálisis/economía , Adulto JovenRESUMEN
AIMS/INTRODUCTION: Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease in China. The current study assessed the cost-effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes from the Chinese healthcare perspective. MATERIALS AND METHODS: A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed type 2 diabetes might receive treatment according to one of the following three strategies: (i) "do nothing" strategy (control strategy); (ii) treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (universal strategy); (iii) or screening for microalbuminuria followed by angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment (screening strategy). Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese healthcare setting were considered. Sensitivity analyses were undertaken to test the impact of a range of variables and assumptions on the results. RESULTS: Compared with the control strategy, both the screening and universal strategies were cost-saving options that showed lower costs and better health benefits. The incremental cost-effectiveness ratio of the universal strategy over the screening strategy was US $30,087 per quality-adjusted life-year, which was higher than the cost-effectiveness threshold of China. The sensitivity analyses showed robust results, except for the probability of developing macroalbuminuria from microalbuminuria. CONCLUSIONS: Screening for microalbuminuria could be a cost-saving option for the prevention of DKD in the Chinese setting.
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Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/economía , Insuficiencia Renal/economía , Pueblo Asiatico , China , Análisis Costo-Beneficio , Nefropatías Diabéticas/prevención & control , Humanos , Cadenas de Markov , Insuficiencia Renal/complicaciones , Insuficiencia Renal/prevención & controlRESUMEN
Background: In type 2 diabetes mellitus (T2DM) patients, chronic kidney disease (CKD) progression may occur without detectable changes in urinary albumin excretion (UAE) rate. A new urinary peptide classifier (CKD273) has exhibited greater ability to detect CKD progression, however, its cost-effectiveness remains unknown. This study evaluated the cost-effectiveness of screening for CKD progression with the CKD273 classifier, as compared to UAE, in diabetic patients. Methods: A decision-analytic Markov model was developed to estimate costs and health outcomes [including overall survival and quality-adjusted life years (QALYs)] from a health system perspective for adopting a new annual screening strategy based on the CKD273 classifier as compared to annual UAE-based screening in a hypothetical cohort of T2DM patients. High-risk patients were defined as T2DM patients with at least one concomitant risk factor (i.e. patients with background genetic risk for developing the disease, obesity, hypertension and/or smoking history) for developing diabetic nephropathy secondary to cardiovascular disease (CVD)-related complications. Low-risk T2DM patients, were defined as those not having any of the aforementioned concomitant risk factors. Results: Over the projected course of a patient's lifetime, in all T2DM patients annual screening with the CKD273 classifier was more costly, but also more effective, than annual screening with UAE. The incremental costs incurred with screening based on the CKD273 classifier were 3,053 per patient, while patients gained 0.13 QALYs. Hence, in all patients, annual screening with the CKD273 classifier was cost effective [incremental cost-effectiveness ratio (ICER) 23,903/QALY gained], notably below current government thresholds for funding such health care interventions. For patients at high risk of developing diabetic nephropathy secondary to CVD-related complications, screening based on the CKD273 classifier was cost-saving (i.e. dominant, being both more effective and less expensive than UAE-based screening). Finally, in low-risk patients, CKD273 classifier-based screening was not cost effective (ICER 73,140/QALY) given current government willingness-to-pay thresholds. Conclusions: In diabetic patients, annual CKD273 classifier-based screening is more costly but also more effective in QALYs gained as compared to UAE. From a health provider perspective, the observed benefits are greatest when such screening is implemented in patients at high risk for diabetes-associated renal or cardiovascular diseases (CVDs).
Asunto(s)
Albúminas/análisis , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/economía , Tamizaje Masivo/economía , Fragmentos de Péptidos/orina , Biomarcadores/análisis , Estudios de Cohortes , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/orina , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Factores de RiesgoAsunto(s)
Nefropatías Diabéticas/epidemiología , Costos de la Atención en Salud , Fallo Renal Crónico/epidemiología , Medicina Preventiva , Australia/epidemiología , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/prevención & control , Progresión de la Enfermedad , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/prevención & control , Exámenes ObligatoriosRESUMEN
AIM: To develop models to estimate the direct medical costs associated with diabetes-related complications in the event year and in subsequent years. METHODS: The public direct medical costs associated with 13 diabetes-related complications were estimated among a cohort of 128 353 people with diabetes over 5 years. Private direct medical costs were estimated from a cross-sectional survey among 1825 people with diabetes. We used panel data regression with fixed effects to investigate the impact of each complication on direct medical costs in the event year and subsequent years, adjusting for age and co-existing complications. RESULTS: The expected annual public direct medical cost for the baseline case was US$1,521 (95% CI 1,518 to 1,525) or a 65-year-old person with diabetes without complications. A new lower limb ulcer was associated with the biggest increase, with a multiplier of 9.38 (95% CI 8.49 to 10.37). New end-stage renal disease and stroke increased the annual medical cost by 5.23 (95% CI 4.70 to 5.82) and 5.94 (95% CI 5.79 to 6.10) times, respectively. History of acute myocardial infarction, congestive heart failure, stroke, end-stage renal disease and lower limb ulcer increased the cost by 2-3 times. The expected annual private direct medical cost of the baseline case was US$187 (95% CI 135 to 258) for a 65-year-old man without complications. Heart disease, stroke, sight-threatening diabetic retinopathy and end-stage renal disease increased the private medical costs by 1.5 to 2.5 times. CONCLUSIONS: Wide variations in direct medical cost in event year and subsequent years across different major complications were observed. Input of these data would be essential for economic evaluations of diabetes management programmes.
Asunto(s)
Complicaciones de la Diabetes/economía , Complicaciones de la Diabetes/epidemiología , Costos de la Atención en Salud , Salud Pública/economía , Anciano , Estudios Transversales , Angiopatías Diabéticas/economía , Angiopatías Diabéticas/epidemiología , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/epidemiología , Retinopatía Diabética/economía , Retinopatía Diabética/epidemiología , Femenino , Hong Kong/epidemiología , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/economía , Infarto del Miocardio/epidemiología , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/epidemiologíaRESUMEN
INTRODUCTION: Diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic foot ulcer (DFU) represent a public health and economic concern that may be assessed with cost-of-illness (COI) studies. OBJECTIVES: (1) To review COI studies published between 2000 and 2015, about DR, DKD and DFU; (2) to analyse methods used. METHODS: Disease definition, epidemiological approach, perspective, type of costs, activity data sources, cost valuation, sensitivity analysis, cost discounting and presentation of costs may be described in COI studies. Each reviewed study was assessed with a methodological grid including these nine items. RESULTS: The five following items have been detailed in the reviewed studies: epidemiological approach (59 % of studies described it), perspective (75 %), type of costs (98 %), activity data sources (91 %) and cost valuation (59 %). The disease definition and the presentation of results were detailed in fewer studies (respectively 50 and 46 %). In contrast, sensitivity analysis was only performed in 14 % of studies and cost discounting in 7 %. Considering the studies showing an average cost per patient and per year with a societal perspective, DR cost estimates were US $2297 (range 5-67,486), DKD cost ranged from US $1095 to US $16,384, and DFU cost was US $10,604 (range 1444-85,718). DISCUSSION: This review reinforces the need to adequately describe the method to facilitate literature comparisons and projections. It also recalls that COI studies represent complementary tools to cost-effectiveness studies to help decision makers in the allocation of economic resources for the management of DR, DKD and DFU.
Asunto(s)
Complicaciones de la Diabetes/economía , Complicaciones de la Diabetes/epidemiología , Proyectos de Investigación , Costo de Enfermedad , Análisis Costo-Beneficio , Pie Diabético/economía , Nefropatías Diabéticas/economía , Retinopatía Diabética/economía , Gastos en Salud , Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Humanos , Modelos Econométricos , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiologíaRESUMEN
AIMS: To evaluate the cost of pharmacotherapy and its determinants in diabetic nephropathy (DN) in the nephrology department of a tertiary care hospital. MATERIALS AND METHODS: A prospective observational study was conducted among adult patients visiting nephrology outpatient department (February-July 2015). Data on demography, investigations, and medications prescribed, direct cost and indirect costs were analyzed. We used Chi-squared test for categorical variables and multivariate linear regression analysis to identify determinants of cost of pharmacotherapy and total cost. RESULTS: Of 100 patients, 50 were above 60 years and 75 were male. Ninety-seven patients had hypertension, which was the most common comorbidity. The majority (60 patients) belonged to Stage 5 DN and 59 patients were on dialysis. The mean number of drugs per patient was 7.60 ± 2.44. The total monthly cost per patient amounted to INR 24,203.27 with total direct cost of INR 21,013.90 (87%) and indirect cost of INR 3189.30 (13%). The monthly cost of dialysis and pharmacotherapy per patient were INR 9060.00 (37%) and INR 2535.98 (11%), respectively. Stage of DN (unstandardized coefficient, B = 7553.96, 95% confidence interval [CI] [6175.09-8932.82], P < 0.001) was a significant determinant of total cost. Number of drugs (B = 636.694, 95% CI [335.670-937.718], P < 0.001) and stage of DN (B = 852.986, 95% CI [297.043-1408.928], P = 0.003) were predictors of cost of pharmacotherapy. CONCLUSION: Stage of DN and number of drugs prescribed were major determinants of cost of pharmacotherapy.
Asunto(s)
Nefropatías Diabéticas/economía , Diálisis/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Fallo Renal Crónico/economía , Medicamentos bajo Prescripción/economía , Adulto , Anciano , Comorbilidad , Costo de Enfermedad , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/epidemiología , Diálisis/estadística & datos numéricos , Economía Farmacéutica , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Centros de Atención Terciaria , Adulto JovenRESUMEN
OBJECTIVE: To summarize characteristics of Medicare beneficiaries with type 2 diabetes and to describe changing trends in care and outcomes. METHODS: We conducted a retrospective cohort study of a nationally representative 5% sample of fee-for-service Medicare beneficiaries 65 years and older with prevalent type 2 diabetes, between January 1, 2002, and December 31, 2011. The main outcome measures were diabetes-related screening tests, mortality, hospital admissions, dialysis, and lower extremity amputation. RESULTS: The average age of Medicare beneficiaries with diabetes was 76.5 years, 56% were women, and 83% were white. Screening practices in beneficiaries with diabetes improved from 2002 to 2011, with rising rates of foot exams, renal screening, hemoglobin A1c tests, and lipid profile tests. The prevalence of nephropathy and neuropathy increased. Although inpatient admissions declined from 2002 to 2011, diabetes-related emergency department visits increased. Amputation and end-stage renal disease remained static, while 1-year mortality declined over the study period. CONCLUSION: In this medically complex group of patients with high comorbidity, we observed improvements in screening practices and room for further improvement. Although the mortality rate decreased, other outcomes did not improve consistently. Health care resource has changed over time, with decreased hospital admissions and increased emergency department visits. ABBREVIATIONS: CCW = Chronic Conditions Data Warehouse ESRD = end-stage renal disease HbA1c = hemoglobin A1c HEDIS = Healthcare Effectiveness Data and Information Set ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification.
Asunto(s)
Atención a la Salud/tendencias , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Medicare/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Atención a la Salud/estadística & datos numéricos , Diabetes Mellitus Tipo 2/economía , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/epidemiología , Neuropatías Diabéticas/economía , Neuropatías Diabéticas/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/epidemiología , Masculino , Medicare/tendencias , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
AIMS: The aim of this study is to assess the impact of the diabetes-related complications on costs and to shed light on the potential savings that could be obtained by the National Healthcare System if better glycemic control was to be achieved in the type 1 diabetes population. METHODS: Epidemiologic data were used to distribute diabetes type 1 patients into A1c levels, and the relative risk of diabetes-related complications associated with the level of A1c was extrapolated from published risk curves. The costs associated with all complications in the Italian settings, retrieved from published literature, were used to estimate the economic impact of complications in each A1c level from the NHS perspective and the potential savings that could be obtained should a treatment strategy allow to achieve better metabolic control. RESULTS: The reduction in the number of complications translates into consistent monetary savings compared to current scenario. Within 5 years, 29 and 33 million would be saved if all patients reduced their A1c level by 1 % and within the range 7-8 % (53-64 mmol/mol), respectively. CONCLUSIONS: This work allows focusing on the impact of managing the diabetes-related complications on the overall costs, not yet reported in the literature. It was shown that the potential savings for the National Healthcare Service associated with a more effective glycemic control are substantial.
Asunto(s)
Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/economía , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/economía , Hemoglobina Glucada/análisis , Glucemia , Costos y Análisis de Costo , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 1/prevención & control , Nefropatías Diabéticas/economía , Nefropatías Diabéticas/terapia , Neuropatías Diabéticas/economía , Neuropatías Diabéticas/terapia , Retinopatía Diabética/economía , Retinopatía Diabética/terapia , Humanos , Italia/epidemiología , Medición de RiesgoRESUMEN
Type II diabetic kidney disease is devastating to patients and society alike. This review will evaluate bariatric surgery as a treatment for diabetic kidney disease primarily through its ability to induce and maintain regression of type II diabetes. The review begins by outlining the global challenge of diabetic kidney disease, its link to obesity, and the comparative benefits of bariatric surgery on weight and type II diabetes. It then surveys comprehensively the relevant literature, which reports that although bariatric surgery is associated with reductions in albuminuria, its effect on harder clinical end points like progression of diabetic kidney disease is not known. The review also includes a critical assessment of the risks and costs of bariatric surgery and concludes by acknowledging the major knowledge gaps in the field and providing research strategies to overcome them. Until these knowledge gaps are filled, clinicians will be forced to rely on their own subjective judgment in determining the benefit-risk ratio of bariatric surgery for patients with diabetic kidney disease.